Agent Application Form

Education Agent Application Form
Please select your Winslow Account Manager:*

UjjwalNehaOther
Details
Legal Entity:*
Trading Name:*
ABN/ACN Number:*
Email*
example@example.com
Phone*

Country CodeNumber
Website:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Section 1: Company Description
Please provide a description of your company:*
Section 2: Key Personnel
Please provide an overview of the key personnel within your company: (Attach additional pages as required)
Contact Name 1:*
Position:*
E mail:*
example@example.com
Phone Number*

Country CodePhone Number
Background*
Contact Name 2:
Position:
E mail:
example@example.com
Phone Number

Country CodePhone Number
Background
Section 3: General
Primary student application cohort*

OnshoreOff shore
What is your main student cohort country of operations? *
Other Target Countries
Are you an authorised agent or member of an agent’s association?*

YESNO
What services do you provide or intend to provide to prospective students?*
Recruitment advice, immigration advice Etc.
Section 4: Referees
Referee 1
Organisation:*
Contact person:
Email*
example@example.com
Phone:*
Website:
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Referee 2
Organisation:*
Contact person:
Email*
example@example.com
Phone:*
Website:
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Document uploads
Company profile

Cancelof
Agent certificates

Cancelof
Other documents

Cancelof
Declaration
As our authorised agent, we are responsible for your actions in marketing our courses, and therefore we expect you to market them with integrity and accuracy as outlined in the National Code 2018 and Education Services for Overseas Students (ESOS) Act 2000. Details can be found at https://internationaleducation.gov.au/Regulatory-Information/Pages/Regulatoryinformation.aspx

Please confirm that you have read and understood National Code 2018 and Education Services for Overseas Students (ESOS) Act 2000 by signing the document.
Print Name*
Date:*

DayMonthYear
Date
Signature*

Clear
Position:*
Should be Empty:

Education Agent Application Form

Details

Section 1: Company Description

Section 2: Key Personnel

Section 3: General

Section 4: Referees

Referee 1

Referee 2

Document uploads

Declaration